Saving lives ain't cheap

Lisa Gross has a Slate article about preventing suicides on the Golden Gate Bridge:

Shortly after 1 pm on 8 March 2013, San Francisco officials pulled the fully clothed body of a 56-year-old white male from the waves off secluded Marshall’s Beach, just south of the Golden Gate Bridge. Police found his car later that night in the parking lot west of the bridge toll plaza. Because no one saw him jump, the coroner’s report made no mention of suicide, even though an investigator told me the pattern of injuries and circumstances suggested “he most likely jumped off the bridge.”
What happened isn’t a mystery. The mystery is why we allowed it to happen.
The Golden Gate Bridge, with its mythic beauty, easy access, and promise of near-certain death, kills an average of thirty lost souls every year, making it among the most popular suicide sites on Earth. Unattached, middle-aged white men are the most frequent victims.
Suicide kills more than six thousand men in their fifties each year, a nearly fifty percent increase over the past decade. Though women are more likely than men to attempt suicide, four times as many men die by suicide. This grim disparity reflects women’s preference for drug overdoses, which allow time for life-saving interventions, and men’s penchant for more lethal means such as guns and jumping from high places, which don’t.
As surely as a leap from the Golden Gate Bridge kills— 98 percent of jumpers die— barriers on suicide hot spots can save lives.
The evidence showing that bridge barriers work is “overwhelming”, says Paula Clayton, professor of psychiatry at the University of New Mexico School of Medicine and former medical director of the American Foundation for Suicide Prevention. Most people die the first time they try to kill themselves. The easiest way to prevent suicide is by restricting access to methods with a high risk of death, Clayton says, such as jumping from a bridge.
A 2013 meta-analysis led by Australian suicide expert Jane Pirkis reviewed studies of deterrents at suicide hot spots around the world. The interventions reduced suicides by jumping at the sites by about 85 percent. Although there was an uptick in jumping at neighboring sites in some cities in the decades after deterrents were erected, the dramatic drop in jumping at the hot spots led to reduced overall rates of suicide by jumping.
Proposals for suicide barriers on America’s legendary landmark date back to the 1950s, but no design stood a chance until 2005, when the Golden Gate Bridge, Highway and Transportation District relaxed its requirement that any deterrent be “totally effective”. Three years later, District officials approved a $45 million net system that would trap a jumper in its flexible stainless-steel cables. But they made their approval an empty gesture by refusing to earmark the toll revenues that typically finance twenty percent of bridge projects.
The District did, however, approve toll funds for a $26.5 million median to separate opposing lanes of traffic to prevent head-on collisions. Since 1970, sixteen people have died when cars veered into oncoming traffic. Over the same period, more than seventy times as many— at least 1,129 people—have leapt to their deaths.
The confirmed count of people lost to suicide since the bridge opened in 1937 now tops sixteen hundred. The number comes from bodies recovered; no one knows how many stole across the rail under cover of darkness or fog and washed out to sea on the ocean-bound current or, like the man found off Marshall’s Beach, weren’t officially counted as jumpers. Most experts think the total death toll exceeds two thousand.
There is an enduring notion that if you erect a barrier on a suicide magnet, people will just go somewhere else. The idea that you can’t stop a suicidal individual is “absolutely false”, says Mel Blaustein, who, as president of the Psychiatric Foundation of Northern California, helped convince bridge officials to approve a deterrent. People often fixate on specific means of suicide, he says. For those drawn to the Golden Gate Bridge, the four-foot rail suggests no one cares if they jump, as one note left on the bridge made painfully clear: “Why do you make it so easy?”
This myth that barriers don’t work was first debunked in 1978 in a landmark study by University of California­ at Berkeley clinical psychologist Richard Seiden, who tracked the fates of 515 people restrained from jumping between 1937 and 1971. Although a few of the thwarted jumpers went on to kill themselves, 94 percent were either alive years later or had died of natural causes. Seiden concluded that the findings underscore the “crisis oriented” nature of suicide.
To better understand the suicidal impulse, a team led by an epidemiologist at the Centers for Disease Control and Prevention interviewed 153 people in a high-risk group: thirteen- to thirty-four-year-olds who nearly died in a suicide attempt. A quarter of the survivors had acted within five minutes of the impulse to do so.
As director of psychiatry at St. Francis Hospital in San Francisco, Blaustein sees suicidal people “every single day of the week”. If you can curb that initial impulsive attempt, he says, patients often realize, even without treatment, that they don’t want to die. Many leave the hospital within 24 hours.
For someone in the throes of misery, it’s hard to overstate the romantic pull of this iconic bridge with its breathtaking views of one of the most beautiful cities in the world, says Ken Holmes, who saw more suicide notes than he cares to remember as the coroner for Marin County, on the northern side of the bridge. “Everybody who jumps off the Golden Gate Bridge from the East Bay drives over the Bay Bridge to do it.”
In a grim milestone in the bridge’s history, a record ten people jumped to their deaths in August of 2013. Many think the Golden Gate Bridge offers a smooth, painless fall into oblivion, Holmes says, but they’re sadly mistaken. Bodies slam into the water some two hundred feet below at roughly 75 miles per hour. That’s enough force to kill many people instantly, if they’re lucky. Others are knocked unconscious, then drown as water pours into their nose and mouth deep beneath the water’s surface. Either way, most jumpers sustain massive injuries to the head and torso, including severed arteries, fractured ribs, punctured lungs, and profuse bleeding from the brain.
Only thirty people have survived a leap from the bridge. Many report that they realized as soon as they jumped that they didn’t want to die and, presumably, many of the dead had the same final thought. As survivor Ken Baldwin told Tad Friend of The New Yorker: “I instantly realized that everything in my life that I’d thought was unfixable was totally fixable— except for having just jumped.” Baldwin jumped in 1985. He recovered, found his calling, and has been teaching high school now for twenty years.
Roughly ninety percent of those who jump from the Golden Gate Bridge and survive do not go on to kill themselves, according to the Bridge Rail Foundation, dedicated to erecting a barrier on the bridge. The figure echoes the findings of a 2002 systematic review, which showed that roughly nine out of ten people who survived a suicide attempt did not subsequently die by suicide.
When the bridge district polled residents in 2008, half of nearly 3,500 respondents objected to a barrier, mostly in the belief that it would not prevent suicide. Many resented spending public funds on people who want to die. “People need to suffer the consequences of their actions,” wrote one commenter. “Better to build a middle barrier for the bridge to help innocent people.” Virtually every article about suicides on the bridge elicits similar sentiments.
Suicide rates have increased nearly thirty percent over the past decade. More people now die of self-inflicted injuries than in car accidents. Though suicide is the tenth leading cause of death, many people fail to recognize it as a public health problem. Clayton thinks that’s because they just don’t understand the terrible suffering that drives people to suicide. Psychological autopsies— in-depth interviews with friends and family to identify causes of suicide— reveal that more than ninety percent of suicide victims were suffering from a mental disorder, usually undiagnosed or untreated, when they died.
In a tragic misunderstanding of the suicidal mind, some see suicide victims as “an inferior breed”, Blaustein says. They don’t realize that someone can sink into despair from an emotional or economic crisis and succumb to suicidal thoughts during a vulnerable time. To someone in intense psychic pain, he says, “suicide is relief.”
Several weeks ago, I walked along the Golden Gate Bridge on a spectacular, cloudless day. As I approached midspan, the most popular place to end one’s life, I saw two young men laughing as they gestured toward a suicide crisis sign. I asked them why they were laughing. “It’s funny,” one of the men told me. “I don’t know why. It just is.”
I walked a bit farther then peered over the rail where hundreds of troubled souls have contemplated their final moments. I stepped up onto the rail’s bottom rung, clutching the top of the cool steel bar. I pictured myself raising my leg over the top of the rail and climbing down to the narrow ledge beneath the walkway, an act that would require very little effort. As I leaned over the rail, watching the waters churning far below, I grew lightheaded, fear swelling in my chest. How much pain would it take to override one of the most primal human instincts: self-preservation?
As I stepped back down to the safety of the walkway, tourists streamed by, snapping photos, laughing, gesturing at the beautiful City by the Bay. How many knew the celebrated bridge they’d traveled so far to admire continues to claim so many lives? Media outlets rarely report on bridge suicides anymore, which in most ways is a good thing. They used to treat jumping as a sport, replete with grisly running tallies of the victims— a despicable practice that experts worried could lead to copy-cat behavior, especially among the young and vulnerable. But, in avoiding stories about those who jump, we make it easier to stigmatize the people who have lost their way, to marginalize the suffering that leads them to desperate acts. And we risk losing sight of the people behind the numbers— our sons, daughters, sisters, brothers, fathers, mothers, friends, and lovers.
How many pedestrians and cyclists streamed past the middle-aged man on that chilly March day, oblivious to the trauma that drove him to end it all? If anyone had asked me how that lifeless body wound up in the frigid waters off Marshall’s Beach, I could have told them about the striking young man who moved from New Jersey to San Francisco 33 years ago, when his penetrating dark brown eyes still flashed with joy. I would have told them how the flashes grew rarer over time, replaced by unexplained fits of rage and mystifying mood swings. I would have said that he pushed away all who cared for him, and that the last time I saw him, nearly a decade ago, the light in his eyes was gone.
Would a suicide barrier have saved his life? We shouldn’t have to ask.

Rico says it's a temptation he'll forego...